|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$12.68
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$735.92 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: Nomi Health Commercial |
$28.62
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$33.39
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.93
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: Priority Health Narrow Network |
$33.93
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$23.85
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.71
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$59.52
|
| Rate for Payer: BCBS Trust/PPO |
$64.98
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: BCN Medicare Advantage |
$59.52
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PACE SWMI |
$59.52
|
| Rate for Payer: PHP Commercial |
$83.33
|
| Rate for Payer: PHP Medicare Advantage |
$59.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.37
|
| Rate for Payer: Priority Health Medicare |
$59.52
|
| Rate for Payer: Priority Health Narrow Network |
$91.37
|
| Rate for Payer: Priority Health SBD |
$24.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.52
|
| Rate for Payer: UHC Medicare Advantage |
$59.52
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$2,273.80 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Medicare |
$35.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.82
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$34.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,273.80
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: BCN Medicare Advantage |
$34.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Cofinity Commercial |
$46.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.33
|
| Rate for Payer: Nomi Health Commercial |
$41.52
|
| Rate for Payer: PACE SWMI |
$34.60
|
| Rate for Payer: PHP Commercial |
$48.44
|
| Rate for Payer: PHP Medicare Advantage |
$34.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.30
|
| Rate for Payer: Priority Health Medicare |
$34.60
|
| Rate for Payer: Priority Health Narrow Network |
$49.30
|
| Rate for Payer: Priority Health SBD |
$49.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.60
|
| Rate for Payer: UHC Medicare Advantage |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$1,708.52 |
| Rate for Payer: Aetna Commercial |
$26.29
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.29
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.52
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.38
|
| Rate for Payer: Priority Health Narrow Network |
$34.38
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.95
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$0.95
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.99
|
| Rate for Payer: Nomi Health Commercial |
$1.14
|
| Rate for Payer: PACE SWMI |
$0.95
|
| Rate for Payer: PHP Commercial |
$1.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.95
|
| Rate for Payer: UHC Medicare Advantage |
$0.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.10 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.10
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.84
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$4.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.99
|
| Rate for Payer: Nomi Health Commercial |
$3.41
|
| Rate for Payer: PACE SWMI |
$2.84
|
| Rate for Payer: PHP Commercial |
$3.98
|
| Rate for Payer: PHP Medicare Advantage |
$2.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.84
|
| Rate for Payer: UHC Medicare Advantage |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,124.00
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$3,811.05 |
| Rate for Payer: Aetna Commercial |
$3,128.71
|
| Rate for Payer: Aetna Medicare |
$2,428.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,362.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,128.71
|
| Rate for Payer: BCBS Complete |
$1,607.82
|
| Rate for Payer: BCBS MAPPO |
$2,334.86
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$3,487.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.86
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cofinity Commercial |
$3,128.71
|
| Rate for Payer: Cofinity Commercial |
$3,362.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.60
|
| Rate for Payer: Meridian Medicaid |
$1,607.82
|
| Rate for Payer: Nomi Health Commercial |
$2,801.83
|
| Rate for Payer: PACE SWMI |
$2,334.86
|
| Rate for Payer: PHP Commercial |
$3,268.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,531.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,330.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,811.05
|
| Rate for Payer: Priority Health Medicare |
$2,334.86
|
| Rate for Payer: Priority Health Narrow Network |
$3,811.05
|
| Rate for Payer: Priority Health SBD |
$3,811.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.86
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.86
|
| Rate for Payer: UHCCP Medicaid |
$1,531.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,357.04
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,903.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$951.47 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Aetna Commercial |
$3,061.31
|
| Rate for Payer: Aetna Medicare |
$2,375.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,289.77
|
| Rate for Payer: BCBS Complete |
$1,573.15
|
| Rate for Payer: BCBS MAPPO |
$2,284.56
|
| Rate for Payer: BCBS Trust/PPO |
$951.47
|
| Rate for Payer: BCN Commercial |
$3,410.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,284.56
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cofinity Commercial |
$3,061.31
|
| Rate for Payer: Cofinity Commercial |
$3,289.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,284.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,398.79
|
| Rate for Payer: Meridian Medicaid |
$1,573.15
|
| Rate for Payer: Nomi Health Commercial |
$2,741.47
|
| Rate for Payer: PACE SWMI |
$2,284.56
|
| Rate for Payer: PHP Commercial |
$3,198.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,284.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,498.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,727.03
|
| Rate for Payer: Priority Health Medicare |
$2,284.56
|
| Rate for Payer: Priority Health Narrow Network |
$3,727.03
|
| Rate for Payer: Priority Health SBD |
$3,727.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,284.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,284.56
|
| Rate for Payer: UHCCP Medicaid |
$1,498.24
|
| Rate for Payer: UMR Bronson Commercial |
$4,095.38
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$2,334.03 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$18.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$17.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,334.03
|
| Rate for Payer: BCN Commercial |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$17.56
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.44
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: PACE SWMI |
$17.56
|
| Rate for Payer: PHP Commercial |
$24.58
|
| Rate for Payer: PHP Medicare Advantage |
$17.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$17.56
|
| Rate for Payer: Priority Health Narrow Network |
$29.25
|
| Rate for Payer: Priority Health SBD |
$29.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.56
|
| Rate for Payer: UHC Medicare Advantage |
$17.56
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.00
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: Nomi Health Commercial |
$10.37
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$12.10
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.36
|
| Rate for Payer: Priority Health Medicare |
$8.64
|
| Rate for Payer: Priority Health Narrow Network |
$14.36
|
| Rate for Payer: Priority Health SBD |
$14.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 36406
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.82
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: Priority Health Narrow Network |
$13.82
|
| Rate for Payer: Priority Health SBD |
$13.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$3,594.55 |
| Rate for Payer: Aetna Commercial |
$200.53
|
| Rate for Payer: Aetna Medicare |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.50
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS MAPPO |
$149.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,594.55
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$149.65
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$200.53
|
| Rate for Payer: Cofinity Commercial |
$215.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.13
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: PACE SWMI |
$149.65
|
| Rate for Payer: PHP Commercial |
$209.51
|
| Rate for Payer: PHP Medicare Advantage |
$149.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.98
|
| Rate for Payer: Priority Health Medicare |
$149.65
|
| Rate for Payer: Priority Health Narrow Network |
$301.98
|
| Rate for Payer: Priority Health SBD |
$62.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.65
|
| Rate for Payer: UHC Medicare Advantage |
$149.65
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
| Rate for Payer: UMR Bronson Commercial |
$238.28
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$1,769.28 |
| Rate for Payer: Aetna Commercial |
$130.11
|
| Rate for Payer: Aetna Medicare |
$100.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.82
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$97.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.28
|
| Rate for Payer: BCN Commercial |
$158.33
|
| Rate for Payer: BCN Medicare Advantage |
$97.10
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.96
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: Nomi Health Commercial |
$116.52
|
| Rate for Payer: PACE SWMI |
$97.10
|
| Rate for Payer: PHP Commercial |
$135.94
|
| Rate for Payer: PHP Medicare Advantage |
$97.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.74
|
| Rate for Payer: Priority Health Medicare |
$97.10
|
| Rate for Payer: Priority Health Narrow Network |
$144.74
|
| Rate for Payer: Priority Health SBD |
$102.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.10
|
| Rate for Payer: UHC Medicare Advantage |
$97.10
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$1,855.92 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Medicare |
$954.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.06
|
| Rate for Payer: BCBS Complete |
$648.58
|
| Rate for Payer: BCBS MAPPO |
$918.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.92
|
| Rate for Payer: BCN Commercial |
$1,408.37
|
| Rate for Payer: BCN Medicare Advantage |
$918.10
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,230.25
|
| Rate for Payer: Cofinity Commercial |
$1,322.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.00
|
| Rate for Payer: Meridian Medicaid |
$648.58
|
| Rate for Payer: Nomi Health Commercial |
$1,101.72
|
| Rate for Payer: PACE SWMI |
$918.10
|
| Rate for Payer: PHP Commercial |
$1,285.34
|
| Rate for Payer: PHP Medicare Advantage |
$918.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,442.01
|
| Rate for Payer: Priority Health Medicare |
$918.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,442.01
|
| Rate for Payer: Priority Health SBD |
$1,442.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.10
|
| Rate for Payer: UHC Medicare Advantage |
$918.10
|
| Rate for Payer: UHCCP Medicaid |
$617.70
|
| Rate for Payer: UMR Bronson Commercial |
$746.58
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$1,725.43 |
| Rate for Payer: Aetna Commercial |
$743.97
|
| Rate for Payer: Aetna Medicare |
$577.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.49
|
| Rate for Payer: BCBS Complete |
$396.75
|
| Rate for Payer: BCBS MAPPO |
$555.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.43
|
| Rate for Payer: BCN Commercial |
$862.52
|
| Rate for Payer: BCN Medicare Advantage |
$555.20
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$743.97
|
| Rate for Payer: Cofinity Commercial |
$799.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.96
|
| Rate for Payer: Meridian Medicaid |
$396.75
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: PACE SWMI |
$555.20
|
| Rate for Payer: PHP Commercial |
$777.28
|
| Rate for Payer: PHP Medicare Advantage |
$555.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$883.46
|
| Rate for Payer: Priority Health Medicare |
$555.20
|
| Rate for Payer: Priority Health Narrow Network |
$883.46
|
| Rate for Payer: Priority Health SBD |
$883.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.20
|
| Rate for Payer: UHC Medicare Advantage |
$555.20
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$267.10 |
| Rate for Payer: Aetna Commercial |
$117.20
|
| Rate for Payer: Aetna Medicare |
$90.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.94
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS MAPPO |
$87.46
|
| Rate for Payer: BCBS Trust/PPO |
$267.10
|
| Rate for Payer: BCN Commercial |
$194.37
|
| Rate for Payer: BCN Medicare Advantage |
$87.46
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$125.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.83
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PACE SWMI |
$87.46
|
| Rate for Payer: PHP Commercial |
$122.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.43
|
| Rate for Payer: Priority Health Medicare |
$87.46
|
| Rate for Payer: Priority Health Narrow Network |
$126.43
|
| Rate for Payer: Priority Health SBD |
$126.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.46
|
| Rate for Payer: UHC Medicare Advantage |
$87.46
|
| Rate for Payer: UHCCP Medicaid |
$60.07
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$1,253.85 |
| Rate for Payer: Aetna Commercial |
$917.78
|
| Rate for Payer: Aetna Medicare |
$712.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.27
|
| Rate for Payer: BCBS Complete |
$480.85
|
| Rate for Payer: BCBS MAPPO |
$684.91
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCN Commercial |
$1,050.17
|
| Rate for Payer: BCN Medicare Advantage |
$684.91
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cofinity Commercial |
$917.78
|
| Rate for Payer: Cofinity Commercial |
$986.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.16
|
| Rate for Payer: Meridian Medicaid |
$480.85
|
| Rate for Payer: Nomi Health Commercial |
$821.89
|
| Rate for Payer: PACE SWMI |
$684.91
|
| Rate for Payer: PHP Commercial |
$958.87
|
| Rate for Payer: PHP Medicare Advantage |
$684.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,069.48
|
| Rate for Payer: Priority Health Medicare |
$684.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.48
|
| Rate for Payer: Priority Health SBD |
$1,069.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.91
|
| Rate for Payer: UHC Medicare Advantage |
$684.91
|
| Rate for Payer: UHCCP Medicaid |
$457.95
|
| Rate for Payer: UMR Bronson Commercial |
$887.34
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$1,753.43 |
| Rate for Payer: Aetna Commercial |
$88.56
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.17
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: BCN Commercial |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$66.09
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$88.56
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.39
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Nomi Health Commercial |
$79.31
|
| Rate for Payer: PACE SWMI |
$66.09
|
| Rate for Payer: PHP Commercial |
$92.53
|
| Rate for Payer: PHP Medicare Advantage |
$66.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.82
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: Priority Health Narrow Network |
$104.82
|
| Rate for Payer: Priority Health SBD |
$104.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.09
|
| Rate for Payer: UHC Medicare Advantage |
$66.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
PR WESTONE MUSICIAN EAR PLUGS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 00591
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
PR WET MOUNTS/ W PREPARATIONS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$703.47 |
| Rate for Payer: Aetna Commercial |
$24.37
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.19
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$18.19
|
| Rate for Payer: BCBS Trust/PPO |
$703.47
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Medicare Advantage |
$18.19
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$21.83
|
| Rate for Payer: PACE SWMI |
$18.19
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$18.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.19
|
| Rate for Payer: UHC Medicare Advantage |
$18.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
